PATHOLOGY LAB 3

VALVULAR HEART DISEASE

J.P. Veinot M.D. FRCPC

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Students examine the specimens with the instructor .

(1) This is a transplant heart (the explanted, diseased heart removed from the patient). The surgeons leave most of the atria in the body to facilitate the anastomosis with the donor heart. This allows us to see the relationship of the valves, with one another, as they all reside at about the same level at the base of the heart. Valves of the heart

a. In the body, which valve sits most anteriorly?

b. The aortic valve is roughly 'wedged' between two valves. Which two?

c. The aortic and pulmonary valves are generically called which kind of valves?

d. The mitral and tricuspid valves are generically called which kind of valves?

e. Trace the course the coronary arteries normally take, and describe which valve each is related to.

Coronary artery diagram

(2) This heart is opened so that the normal aortic and mitral valves are exposed. Notice the largest mitral leaflet, which is the anterior leaflet, and its relationship to the interventricular septum.

For the mitral valve, identify: (i) the annulus (ii) the leaflets (iii) the closing margins of the leaflets (iv) the free edge of the leaflets (v) the chordae tendineae (chords) (vi) the papillary muscles (vii) the commissures

(3) Again, this heart's valves are reasonably normal. Notice the coronary artery ostia exiting from the aortic valve sinuses.

For the aortic valve, identify: (i) the annulus (ii) the cusps (iii) the closing margins of the cusps (iv) the free edge of the cusps (v) the sinuses (vi) the commissures Photo of aortic valve

Notice the location of the membranous septum. Where is the AV node in relation to the membranous septum and the aortic valve?

(4) This heart illustrates the commonest cause of mitral valve insufficiency.

a. What is it? Heart with mitral insufficiency

b. What are other terms for 'insufficiency'?

c. What are other mechanisms by which insufficiency may develop?

d. What happens to the heart chambers in mitral insufficiency and why?

e. The surgical specimen demonstrates a mitral valve with myxomatous degeneration. This may be asymptomatic or cause mitral regurgitation. The condition is also known as mitral valve prolapse or "floppy" mitral valve. Mitral valve

(5) This is a surgically excised specimen. This is the commonest lesion causing mitral valve stenosis.

a. How would you describe the valve? Mitral valve stenosis

b. Why is it stenotic?

c. What happens to the heart chambers in mitral stenosis and why?

(6) There are 3 main processes which cause aortic valve stenosis:

 

scarring after rheumatic fever and valvulitis in childhood

 

age-related degenerative calcification

 

reactive calcification of a congenital bicuspid aortic valve

 

a. Which is this surgical specimen most likely an example of? Stenotic aortic valves three causes

b. What are mechanisms by which aortic valve insufficiency may develop?

c. What happens to the heart chambers in aortic regurgitation/aortic stenosis ? why?

 

(7)   Prosthesis